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1 SETBACK& & FOPtIR :
Date By
2 FOUNDATION. WALLS.:
Date By
3 PLUMBING GROUNDWORK
Date By
4 SLAB INSULATION
Date By
MOOTINGJDOWNSPOUT DRAINS
Date By
7UNDERFLOOR FRAMING ..
Date By
7 SHEAR WALLS d a $ G
Date By
8 PLUMBING ROUGHMIN
Date By
70AS PIPING ..... .
Date By
10 MECHANICAL ROUGH -IN -
Date By
11 FRAMING .
Date By
12 INSULATION
Date By
13 OWS - I'ST LAYER .
Date By
7147
GW8 - 9N,q LAYER
Date By
15 SUSPENDED CEILING
.75.
Date By
16 PLANNING FINAL
Date By
17 PUBLIC. WORKS FINAL
Date By
18 FIRE FINAL
7
Date By
19 BUILDING''FINAL.
Date2&Y
20 OTHER
Date By
CDO193 (Rev 4/97)
PLEASE PRIM'
BUILDING DIVISION
arroF 33530 First Way South
�pERj Federal Way, WA 98003
CITY OF FEDERe4l. WA�1 Fax (253) 6614129
' 335301St Way South
<YiWFederal Way, WA 98003
APPLICATION FOR BUILDING PERMIT
APPI MATION 4 F) Ll-1 OA - C Zh I
Address
Tenant (if known)
Lot #
Assessor's Tax #
Building Owner's Namggn t
} L-,W�S
Address .
city
State LOJJ
Zip
lPhonea-
Nature of Work is [,•
Name (F,M,L)
Address ,-�� a4 -I -3-tA.- , A- . , 1:�,6 I
City State LA-3zip
C, ntact erson lay Phone Other _PI n Fax
s
Company Name
Address
c3
City i'
State
Zip
Contact Person
Phone , Y7 ra
Fax
t i � '
Contractor's # (card must be presented)
Expiration Date
Verified ❑ Yes ❑ No
.;;.,,
---------------------
.,
Name
Address
City
State
Zip
Contact Person
Phone
Fax
LEGAL DESCRIPTION
IN
-
Existing Use
,
Proposed Use
Permit includes:
EY-Building❑
Plumbing
❑ Mechanical
1:3
Other
Type of Work:
❑ Residential
Commercial
❑ New
❑ Addition
❑ Remodel
❑ Garage
❑ Number of Units
❑ Shed f
❑
❑
Deck
Other
Enter 1 at Floor
Area Basement
sq ft
sq ft
2nd Floor
Decks
sq ft 3rd Floor sq ft
sq ft Garage sq ft
Existing Floor Area
Proposed Total Area
sq ft
sqft
Water Availability
❑ Sewer Availabilit ❑ On -Site Septic System Availability ❑
Project Valuation
$
�
Zoning
Lot Size
Existing Bldg Valuation
$
Name
Address
Contractor Name
Address
Ci
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinkina Fountains Other
Water Heaters
Lavatories I Washing Machine I Drains I Total Fixture -Count:. .1
Fuel T e (electric/other)
MECHANICAL EVALUATION ONLY $
Gas Dryer
Air Handling < = 10,000 CFM
15-30 Tons
Length of Gas Piping
Range
Air Handlin > = 10,000 CFM
30-50 Tons
Furn <100K BTUs
Gas Log
Unit Heater
50+ Tons
Furn > 100 BTUs
Fans
Miscellaneous
Fuel Tanks
Gas Hwt
Hood
Boilers
Above Ground
Conv Burner
Duct Work
0-3 Tons
Underground
BBQ's
Wood Stoves
3-15 Tons
Total --Unit Count
DISCLAIMER: I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I am authorized by the owner of
the above premises to perform the work for which permit application is made. I further agree to save harmless the City of Federal Way as to any claim (including costs, expenses, and
attomeys' fees incurred in investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the City of Federal Way, but only
where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of this application.
Owner/Agent:� �- Date: ' r C �.5 /e:�>
auiu m.Aw
REMED 0126/97